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McGrath A, Lambe B, Matthews E, McDonnell K, Harrison M, Kehoe B. Determinants of physical activity promotion in primary care from the patient perspective of people at risk of or living with chronic disease: a COM-B analysis. BMC PRIMARY CARE 2024; 25:190. [PMID: 38807071 PMCID: PMC11134685 DOI: 10.1186/s12875-024-02440-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Chronic disease (CD) accounts for more than half of the overall global disease burden and physical activity (PA) is an established evidence-based strategy for the prevention and management of CD. Global policy emphasises the value of embedding PA into primary healthcare, highlighting the positive effects on PA behaviour. However, there is limited implementation of PA protocols in primary care, and research is needed to guide its integration into routine practice. The voice of the patient is underrepresented in the literature, resulting in the absence of critical insights into determinants of PA promotion in primary care. The purpose of the research was to identify the perspectives of people at risk of or living with CD on the determinants of PA promotion in primary care and to map these determinants across the six COM-B constructs. METHODS Semi-structured interviews (n = 22), guided by the COM-B model were conducted with people aged 35-60 years, at risk of or living with CD and not meeting the PA guidelines. A hybrid analytic approach of thematic inductive and deductive analysis was applied to the participant transcripts guided by a COM-B informed coding framework. RESULTS In total, 37 determinants across constructs related to capability, opportunity and motivation were prominent, examples include; physical capability constraints, the conflation of exercise with weight management, credibility of the health services in PA advice, communication styles in PA promotion, expectations of tailored support for PA, social support, accessibility, and integration of PA into routine habits. CONCLUSION Exploring the determinants of PA promotion through the lens of the COM-B model facilitated a systematic approach to understanding the primary care user perspective of the healthcare professional (HCP) broaching the topic of PA. Findings emphasise the value of HCPs being supported to broach the issue of PA in a therapeutic and patient-centred manner using diverse and flexible approaches, while highlighting the importance of tailored, accessible PA opportunities that build self-efficacy and foster social support. The research provides valuable learnings to support PA promotion and the development of strategies in primary care through encompassing the perspective of those living with or at risk of CD.
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Affiliation(s)
- Aisling McGrath
- Centre for Health Behaviour Research, Department of Sport and Exercise Science, South East Technological University, Waterford, Ireland
| | - Barry Lambe
- Centre for Health Behaviour Research, Department of Sport and Exercise Science, South East Technological University, Waterford, Ireland.
| | - Evan Matthews
- Centre for Health Behaviour Research, Department of Sport and Exercise Science, South East Technological University, Waterford, Ireland
| | - Karolyn McDonnell
- National Centre for Men's Health, South East Technological University, Carlow, Ireland
| | - Michael Harrison
- Centre for Health Behaviour Research, Department of Sport and Exercise Science, South East Technological University, Waterford, Ireland
| | - Bróna Kehoe
- Centre for Health Behaviour Research, Department of Sport and Exercise Science, South East Technological University, Waterford, Ireland
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Hanmer SB, Tsai MH, Sherrer DM, Pandit JJ. Modelling the economic constraints and consequences of anaesthesia associate expansion in the UK National Health Service: a narrative review. Br J Anaesth 2024; 132:867-876. [PMID: 38341282 PMCID: PMC11103085 DOI: 10.1016/j.bja.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/07/2024] [Accepted: 01/15/2024] [Indexed: 02/12/2024] Open
Abstract
Shortages in the physician anaesthesia workforce have led to proposals to introduce new staff groups, notably in the UK National Health Service (NHS) Anaesthesia Associates (AAs) who have shorter training periods than doctors and could potentially contribute to workflow efficiencies in several ways. We analysed the economic viability of the most efficient staffing model, previously endorsed by both the UK Royal College of Anaesthetists and the Association of Anaesthetists, wherein one physician supervises two AAs across two operating lists (1:2 model). For this model to be economically rational (something which neither national organisation considered), the employment cost of the two AAs should be equal to or less than that of a single supervisor physician (i.e. AAs should be paid <50% of the supervisor's salary). As the supervisor can be an autonomous specialty and specialist (SAS) doctor, this sets the economically viable AA salary envelope at less than £40,000 per year. However, we report that actual advertised AA salaries greatly exceed this, with even student AAs paid up to £48,472. Economically, one way to justify such salaries is for AAs to become autonomous such that they eventually replace SAS doctors at a lower cost. We discuss some other options that might increase AA productivity to justify these salaries (e.g. ≥1:3 staffing ratios), but the medico-political consequences of each of them are also profound. Alternatively, the AA programme should be terminated as economically nonviable. These results have implications for any country seeking to introduce new models of working in anaesthesia.
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Affiliation(s)
- Stuart B Hanmer
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Mitchell H Tsai
- Department of Anesthesiology, Orthopedics and Rehabilitation, and Surgery, Larner College of Medicine, University of Vermont, Burlington, VT, USA; Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Anesthesiology and Perioperative Medicine, University of Alabama Birmingham, Birmingham, AL, USA
| | - Daniel M Sherrer
- Department of Anesthesiology and Perioperative Medicine, University of Alabama Birmingham, Birmingham, AL, USA
| | - Jaideep J Pandit
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
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Spitz KE, Nguyen HP, Blalock TW. What is in a Name? Implications of a Title Change From Physician Assistant to Physician Associate. Dermatol Surg 2022; 48:703. [PMID: 35510861 DOI: 10.1097/dss.0000000000003461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kathleen E Spitz
- All authors are affiliated with the Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
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Straughton K, Roberts KA, Watkins J, Drennan VM, Halter M. Physician associates in the UK: Development, status, and future. JAAPA 2022; 35:56-60. [PMID: 35192555 DOI: 10.1097/01.jaa.0000819544.87720.fb] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Physician associates (PAs) have been part of the UK health workforce for almost 20 years. The profession is growing rapidly with statutory regulation, protection of the title, and career progression supported by a national-level framework all in the pipeline for the near future. This article provides a brief history of the profession in the United Kingdom and prospects for its future.
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Affiliation(s)
- Kate Straughton
- Kate Straughton is president of the Faculty of Physician Associates in the Royal College of Physicians and a senior lecturer at the University of Birmingham in the UK. Karen A. Roberts is a reader in PA education and director of the PA program at Brighton and Sussex Medical School in Falmer, UK. Jeannie Watkins is a reader in PA education and course director of the PA program at St. George's, University of London. In the Centre for Health and Social Care Research at Kingston University and St. George's University of London in the UK, Vari M. Drennan is a professor of healthcare and policy research and Mary Halter is an associate professor. Ms. Watkins discloses that she is a director of and holds a 10% share in PATH, a recruitment company for PAs, but receives no money from the organization. The authors have disclosed no other potential conflicts of interest, financial or otherwise
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Saslaw M, Kaplan S, Pavlicova M, Rosenbaum M, Sirota DR. Evaluation of Physician Assistants’ Self-Reported Attitudes and Behaviors After Completion of a Hospital-Wide Multidisciplinary Communication Skills Training Workshop. J Patient Exp 2022; 9:23743735221092626. [PMID: 35425849 PMCID: PMC9003642 DOI: 10.1177/23743735221092626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Physician's assistants (PA) are an integral part of hospital teams. To the best of our knowledge, this is the first study to examine the effects of a multidisciplinary hospital-wide communication skills training (CST) workshop on PAs. From November 2017 to November 2019, all participants in the CST workshop were sent a web-based retrospective pre-post survey to measure self-reported attitudes and behaviors related to communicating with patients, CST, and specific skills taught. PA responses were analyzed alone and were compared to non-PAs. Non-PAs were physicians and 1 nurse practitioner. In total, 258 PA and 333 non-PA participants were surveyed for an overall response rate of 25%. Among PAs, in 9 out of 10 domains measured, there was a significant change in self-reported attitudes and behaviors toward communicating with patients, CST, and skills taught (P < .05). Similar to other providers, PAs experienced positive changes in these self-reported attitudes and behaviors after CST, however, there were some significant differences found when comparing PAs and non-PAs in the covariate analysis.
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Affiliation(s)
- Minna Saslaw
- Division of Child and Adolescent Health, Columbia University Irving Medical Center, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | | | - Martina Pavlicova
- Irving Center for Clinical and Translational Research, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Marcy Rosenbaum
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Dana R. Sirota
- Division of Child and Adolescent Health, Columbia University Irving Medical Center, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
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Abstract
As the physician associate (PA) profession grows and awareness about the role increases, it is important to understand how PAs promote patient safety. In this article, we explore the current literature regarding the contribution of PAs to patient safety, considering their training, day-to-day clinical work and influence on recognised factors that affect patient safety.
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Affiliation(s)
- Laura Chenevert
- New York-Presbyterian/Columbia University Irving Medical Center, New York, USA
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Malone R. The role of the physician associate: an overview. Ir J Med Sci 2021; 191:1277-1283. [PMID: 34351601 DOI: 10.1007/s11845-021-02661-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/25/2021] [Indexed: 10/20/2022]
Abstract
The physician assistant role in healthcare delivery was first introduced during the 1960s in the USA as a solution to doctor shortages, greater population healthcare needs and increasing healthcare provision costs. Since then, many countries worldwide have utilized the successful USA physician assistant model as a benchmark to guide both physician assistant training and the incorporation of the role into their healthcare systems. While the USA retained the title physician assistant, Ireland and the UK use the title physician associate. Physician assistants/associates are trained in the generalist medical model and function under the supervision of a doctor. Tasks relating to the role include the following: taking patient's medical histories, performing examinations, making diagnosis, requesting tests, analysing results and the initiation of treatment. They practice across a broad range of specialities and settings. Physician assistants in the USA and the Netherlands have prescribing privileges. Statutory regulation for physician assistants/associates lays the groundwork for prescribing privileges and such regulation is under consideration by the government in the UK. Studies indicate that doctors and patients are largely satisfied with the contribution of this profession to healthcare services and physician assistants/associates report good job satisfaction.
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Affiliation(s)
- Rachel Malone
- Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
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Validation and Adjustment of the Patient Experience Questionnaire (PEQ): A Regional Hospital Study in Norway. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137141. [PMID: 34281076 PMCID: PMC8296920 DOI: 10.3390/ijerph18137141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/11/2021] [Accepted: 06/30/2021] [Indexed: 11/22/2022]
Abstract
This paper assesses the psychometric qualities of the Patient Experience Questionnaire (PEQ), thereby validating a patient-oriented measurement model in a hospital environment, and modifies the model based on empirical results. This study employed survey data gathered by the Norwegian Institute of Public Health from adult inpatients at somatic hospitals in the Health South-East RHF in Norway. The survey engaged 4603 patients out of 8381 from five main hospitals in the region. The study found that an eight-factor model of the PEQ generally showed good fitness to the data, but assessment of discriminant validity showed that this was not the optimal factor solution among four of the eight dimensions. After comparing models, the study proposed a model with a second-order factor for four of the factors: “nurse services”, “doctor services”, “information”, and “organization”, collectively named “treatment services”. The proposed model demonstrated good validity and reliability results. The results present theoretical and practical implications. The study recommends that inferential analyses on the PEQ should be done with the second-order factor. Furthermore, a revision of the PEQ is recommended subject to more confirmatory studies with larger samples in different regions. The study indicates a second-order factor structure for assessing and understanding patient experiences—a finding which has both theoretical and managerial implications.
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Abstract
This article describes the 10-year journey of a research group helping to build the research evidence base for physician assistants (PAs), known as physician associates in the United Kingdom, in the National Health Service in England. It draws out some key issues that may be of interest to those developing PA research programs in different specialties and different countries. PA research also can help healthcare policy makers address growing demand, issues of quality, and cost.
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Taylor F, Ogidi J, Chauhan R, Ladva Z, Brearley S, Drennan VM. Introducing physician associates to hospital patients: Development and feasibility testing of a patient experience-based intervention. Health Expect 2020; 24:77-86. [PMID: 33238078 PMCID: PMC7879547 DOI: 10.1111/hex.13149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/10/2020] [Accepted: 10/15/2020] [Indexed: 01/14/2023] Open
Abstract
Background Physician associates (PAs) are one of many new mid‐level health practitioner roles being introduced worldwide. They are a recent innovation in English hospitals. Patient confusion with novel mid‐level practitioner titles and roles is well documented, alongside evidence of a positive association between patients’ ability to identify practitioners and patient satisfaction. No prior research developed an intervention to introduce PAs or any other new practitioner role to hospital patients. Objective To develop, with patient and public involvement and engagement (PPIE), an intervention for introducing the PA role to hospital patients, and to test feasibility. Methods Intervention development was underpinned by an experience‐based co‐design approach. Workshop participants generated ideas for introducing PAs, subsequently explored in semi‐structured interviews with hospital patients (n = 13). Interview findings were used by participants in a second workshop to design the intervention. Feasibility of the intervention was assessed in relation to its acceptability and efficacy using semi‐structured interviews with hospital patients (n = 20) and PAs (n = 3). Results The intervention developed was a patient information leaflet. It was considered feasible to use in the hospital setting, helpful to patients in understanding the PA role and acceptable to both patients and PAs. The intervention was also appreciated by patients for providing reassurance of care and support. Conclusions An experience‐based co‐design approach enabled development of an intervention tailored to patients’ experiential preferences. Positive evidence of feasibility and utility is encouraging, supporting future larger‐scale testing. Patient and public contribution PPIE representatives were involved in the study design, intervention development and data interpretation.
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Affiliation(s)
- Francesca Taylor
- Joint Faculty of Kingston University and St George's University of London, St George's University of London, London, UK
| | - Jonathan Ogidi
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Rakhee Chauhan
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Zeena Ladva
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sally Brearley
- Joint Faculty of Kingston University and St George's University of London, St George's University of London, London, UK
| | - Vari M Drennan
- Joint Faculty of Kingston University and St George's University of London, St George's University of London, London, UK
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